全膝关节置换后高负压引流下的隐性失血

背景：通常评价关节置换患者出血量主要是记录置换中的出血量和置换后的引流量，这些只是显性失血量，研究表明隐性失血量可达到并超过总量的50%。 目的：比较全膝关节置换高负压引流和普通负压引流失血量，评价高负压引流对全膝关节置换隐性失血的影响。 方法：60例单侧全膝人工关节置换患者根据置换后采用的负压吸引不同分为高负压引流组和普通负压引流组(对照组)，每组30例。通过Gross方程推算，对膝关节置换后总失血量(显性失血量+隐性失血最)和输血量进行分析，并对两组置换后并发症及功能恢复状况进行比较。 结果与结论：高负压引流组患者总失血量为(646±184) mL，隐性失血量为(215±128) mL；对照组患者总失血量为(867±296) mL，隐性失血量(457±268) mL；高负压引流组总失血量及隐性失血量均明显少于对照组(P < 0.05)。高负压引流组平均输血量224 mL，对照组平均输血量467 mL。单侧全膝关节置换后采用高负压引流，总失血量、隐性失血量及置换后输血量均少于对照组，尤其是隐性失血量的减少，有利于病情的观察、处理，规避潜在的风险，有利于置换后膝关节功能的恢复。

Hidden blood loss in total knee arthroplasty under high negative pressure drainage

BACKGROUND:Usually, amount of bleeding during replacement and drainage amount after replacement were recorded to evaluate the amount of bleeding in patients with arthroplasty. These are dominant blood loss. Studies demonstrated that recessive blood loss exceeded 50% of total amount. OBJECTIVE:To compare the blood loss during total knee arthroplasty under high negative pressure drainage and common negative pressure drainage and to assess the effect of high negative pressure drainage on hidden blood loss in total knee arthroplasty. METHODS:A total of 60 patients undergoing lateral total knee arthroplasty were equally divided into high negative pressure drainage group and conventional drainage group (control group). We calculated the total blood loss (dominant blood loss and hidden blood loss) and blood transfusion amount with the Gross equation. The recovery after surgery and complications were compared. RESULTS AND CONCLUSION:In high negative pressure drainage group, the total blood loss was (646±184) mL and the hidden blood loss was (215±128) mL. In the control group, the total blood loss was (867±296) mL and the hidden blood loss was (457±268) mL. The total blood loss and hidden blood loss in the high negative pressure drainage group were significantly less than those in the control group (P < 0.05). The average blood transfusion amount was 224 mL in the high negative pressure drainage group and 467 mL in the control group. Following unilateral total knee arthroplasty, total blood loss, hidden blood loss and blood transfusion amount after arthroplasty were less in the high negative pressure drainage group than those in the control group. In particular, the decrease in hidden blood loss was helpful to observe and treat the pathogenetic condition and to avoid potential risk, and benefits the recovery of knee joint function after surgery.